In an extremely engaging session at the BW Businessworld’s 4th Healthcare Summit and Awards, called the Government and CEO Session: Exploring Synergies between Public and Private Sector, moderated by Sudhir Mishra of Trust Legal, Mishra began by saying, “There is a big crisis so far when public trust is concerned. The trust between doctor and patient, and the trust between public and private enterprise”. He asked one of the panellists, Mr Rajiv Kumar Jain, Additional Chief Medical Director (Health & Family Welfare) Joint Food Safety Commissioner, Indian Railways, about the rupture of the relationship between the doctor and the patient, the government and private sector, and how they all can be aligned one day.

Jain replied by saying “I believe there is an explosion of expectations which is good for the country. Expectations have risen to a very high level, so it would appear superficially that a rupture has happened. In reality, it has not.” He continued by adding, “Public healthcare infrastructure and private healthcare infrastructure has a lot of finances available from multiple sources, it’s a revolution. One could never visualize that this would happen 10 years back. Despite all the liberalization and development, no one could visualize that this kind of money would be available to be invested for public health care system in our country. When we speak about the public health care system, it does not divide the application on the ground, the system of management on the ground, whether it is privately managed or publicly managed. Ultimately it is the delivery of the healthcare services which matters.”

Speaking about centrally sponsored schemes for healthcare for public servants, Jain said, “I am cocooned out of the government of India by virtue of belonging to the Indian railways, which is a government within the government. Managed by the government of India, funded by Parliament, regulated by Parliament, yet no similar system exists within the country. There exists a central government health scheme- a subscription based scheme to which all officers of the central government have to subscribe to and they have to pay for it.” He added, “For the Indian railways, 13.92 lakh railway employees get health benefits, it's a fundamental right, without contributing at all. Globally there is no parallel of this kind, 8.4 million beneficiaries continue to get end-to-end care without contribution. And it is happening in a developing country like India, and it is sustainable as there is a revenue model. And unlike CGHS, this is PAN India, same procedure, same standards.”

Addressing Astitva Pandey, Director, Corporate Finance and Real Estate, YES Bank, Mishra asked, “From a financial point of view, what kind of public health system do we want?”, to which Pandey replied, “India is lagging behind with respect to global benchmarks. Government and private sector both have to play a role. The government has a role right from the land stage when the private sector has to get land acquisition to build the hospital, till the point when the patient comes to the hospital and how the funding of the medical expenditure takes place.” He further added, “You need land to set up a hospital. Getting land which is close to the vicinity of the population, requires a huge number of approvals from the central government. At an early stage, the government has to give land approval and all, where most of the funding goes haywire. So getting the approval gets delayed, which is the approval for getting the building constructed. So the first and foremost role the government has to play is ensuring that the approval to the private sector partner is expedited.”

He went on to add, “So the process of delivery of the approval needs to get expedited, to make sure the cost of the project does not go up while getting the approval. Then comes the financing of the project. Healthcare is a segment doesn’t give ROI’s which other projects give as far as investment is concerned from a financial point of view. For the funding part of it, the government needs to come up with an advanced or an upgraded sort of funding mechanism.”

Speaking to Dr NK Pandey, Chairman & Managing Director, Asian Institute of Medical Sciences, Mishra asked, “What is your expectation of the government when you’re doing everything right, meeting all parameters and so on?”, to which Pandey replied, “I have been very lucky, as my local government, where I was working, I got the approval within 7 days. So I can’t complain on that account, they cleared the construction permits in 7 days. We should take care of all environmental issues before we establish a hospital. It’s very important that the project gets done on time as otherwise, the costs go up rapidly. That’s where the banker starts getting hiccups.” He went on to add, “If you allow time travel, and we travel back to the 19th century and today, we will find similar problems in the hospital. Despite all the technology advancements, similar problems exist. There exists a communication gap between the doctor and patient. There is no doubt it. The way to fill it up is to communicate better, talk better.” He also added, “PPP in the country has been grossly unsuccessful, the reason being that the trust between government and private sector is not established, it doesn’t matter how many papers NITI Aayog publishes, the project will not go ahead. The funding gap in the healthcare sector can’t be substantiated by the private sector. Government has to push up its spending”

Speaking about the gaps in medical education, Jain said, “Medical education in its very nature, whether in India or abroad has never focused on expertise training and skill in hospitality, of care and service. If teachers are themselves not taught about medical education is all about, how do you expect students to have those skills. That’s too much to expect from a student.” Mishra went on to close the session by stating, “Doctors and hospitals should be united in some forum. Doctors can’t be just united in their practice area, they have to go beyond that.”